Metal nanoclusters (NCs) have recently attracted great interest in biomedical applications due to their ultrasmall size, good biocompatibility, and unique molecule-like physical and chemical properties. Metal NCs can be rationally designed and integrated with various targeting moieties to achieve unique physicochemical properties and functions. For therapeutic applications, these multifunctional surface-modified NCs can provide distinctive advantages over native metal NCs, such as improved therapeutic effects and reduced side effects. In this review, the design principles of targeting strategies for metal NCs and their composites, including passive and active targeting, and physical and chemical targeting are first discussed. The authors then focus on the recent achievements in the application of metal NCs in targeted therapeutics, including chemotherapy, phototherapy, and radiotherapy. Finally, the authors' perspectives on the challenges and opportunities of developing metal NCs in targeted therapeutics, further paving their way for potential clinical applications are provided.